Town of Winthrop : Record of Deaths 1935, Part 87

Author: Winthrop (Mass.)
Publication date: 1935
Publisher:
Number of Pages: 524

USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1935 > Part 87

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Statement of cause of death .- Cause of death means the disease, or complication which causes death, not the mode of dying, e. g., heart failure, asphyxia, asthenia, etc. As principal cause name the disease causing death. As related causes, name earlier morbid conditions, if any, related to the principal cause and any important complication of the principal cause. Under contributory causes of importance not related to principal cause, name other important diseases.

Example

The principal cause of death and related causes of importance in order of onset were as follows:

Date of onset

Arteriosclerosis

1915

...

Chronic interstitial nephritis

1021

Cerebral hemorrhage

July 5. 1927

Contributory causes of importance not related to principal cause :

...

In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first, second, or third position. The principal cause in the above example happens to be the second cause given.

RETURN OF CERTIFICATES OF DEATH

A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .... Gen. Laws, Chap. 46, Sec. 9.

No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the board of health, or employed by it or by the selectmen for the purpose, shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the common- wealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such re- moval; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as re- quired by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so 1 given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be · obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Chap. 114, Sec. 45, G. L., (Tercentenary Edition.)

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.

.... He shall in all cases certify to the town clerk or registrar in the place where the deceased died his name and residence, if known; otherwise a description as full as may be, with the cause and manner of death .- Gen. Laws, Chap. 38, Sec. 7.

No undertaker or other person shall bury a human body or the ashes thereof which have been brought into the commonwealth until he has received a permit so to do from the board of health or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the body is to be buried or the funeral is to be held, or from a person appointed to have the care of the ceme- tery or burial ground in which the interment is made .... Chap. 114, Sec. 46, G. L., (Tercentenary Edition:)

RULES OF PRACTICE

The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.

(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease un- related to any form of injury, have died without recent medical attend- ance or whose physician is absent from home when the certificate of death is needed.

(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons), thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occupation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.

MM R-301

OCCUPATION is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state N. B .- WRITE PLAINLY, /WITH UNFADING BLACK INK-THIS IS A PERMANENT RE ,RD. Every item of PARENTS 100m-12-'32. No. 7070-h

Cambridge

mitific 11/6/35 caracteres copy for state

Camb 1 1/27/35

(City or town making return )

Registered No.

206

(If death occurred in a hospital or institution, give its NAME instead of street and number )

(If U. S.

War Veteran,

specify WAR)

(a) Residence. No ....

(Usual place of abode)

Length of residence in city or town where death occurred

yrs.

.2.4 ... Notre ... Dame ..... venue.

.St., .... Ward, Cambridge, .. Lass

(If nonresident, give city or town and state)

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

3 SEX

4 COLOR OR RACE

(write the word)

female white

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

single

5a If married, widowed, or divorced

HUSBAND of

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here. Stillborn

7 AGE - Years - Months - Days

If less than 1 day - Hours ... ....... Minutes

8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc.

9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.

10 Date deceased last worked at

this occupation (month and

year)

11 Total time (years) spent in this occupation

12 BIRTHPLACE (City)

-Avere++- Winthrop

(State or country) Massachusetts

13 NAME OF

FATHER

Joseph R. Sampson

14 BIRTHPLACE OF

FATHER (City)

Plymouth

(State or country) Massachusetts

15 MAIDEN NAME

OF MOTHER

16 BIRTHPLACE OF

MOTHER (City)

Anna

M. Higgins

(State or country) Ireland

17 Joseph R. Sampson (father)

Informant (Address)

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burjal or wansit permit was issued:

ASignature of Agent of Board of Health of other) Health Sular (Official Designation)" (Date of Issue of Permit)/

10/90 35

MEDICAL CERTIFICATE OF DEATH

18 DATE OF DEATH October

1935

(Month)

(Day)

(Year)

19 I HEREBY CERTIFY, That I attended deceased from

/ last saw h

alive on

19 .......... , death is said

to have occurred on the date stated above, at. -

The principal cause of death and related causes of importance in order of onset were as follows: Stillborn. enroute to. Station

Hospital, ... Fort ... Banks, ... Mas.s ..

Date of Onset 10-20- 1935

Contributory causes of importance not related to principal cause:

Name of operation

What test confirmed diagnosis?

Was there an autopsy? No

20 Was disease or injury in any way related to bocupation of deceased?

If so, specify

Fra-02. Star b

(Signed)

JANTES B. SLAP,

TAP ATOM

(Address) Sta Hosp. Ft. Banks

M. D.

Date ... Q.c.12.9.19.35.

StPaul's Al

21 PLACE OF BURIAL,

CREMATION OR REMOVAL

DATE OF BURIAL

Oct 31

1935

22 NAME OF

Timothy SA Leanelly

UNDERTAKER

ADDRESS

no Carb

Received and filed ART ::

A TRUE COPY, ATTEST:

(Registrar)

Ward {

Barbara Ann Sampson

(If deceased is a married, widowed or divorced woman, give also maiden name.)

mos.

days.

How long in U. S., if of foreign birth?

yrs.

19 ........ , to

.Date of

(City or town)

Supfach (County) Winthrop 1 (City or Town) No.Enroutefrom Cambridge,Mass to St. PLACE OF DEATH Station Hospital, Fort Banks, Mass. 2 FULL NAME

The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH

Revised United Rates Standard Certificate of Death

Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper -- private family, cook-hotel, etc. For a person who had no occupation what- ever write none.

To be complete, an occupation return must state: / 1

8 .- The trade, profession, or particular kind of work done.

9 .- The industry or business in which the work was done.

10 .- The month and year the deceased last worked at the occupation.

11 .- The number of years the deceased followed the occupation.

In stating the occupation, avoid the use of such indefinite terms as "employee," "worker," "operative," etc. Find out the parti- cular kind of work done and return that, as spinner. weaver, etc.

In stating the industry or business, avoid the use of such general terms as "store. " "factory." "mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.

Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter, painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.

Example

The principal cause of death and related causes of importance in order of onset were as follows: Arteriosclerosis

Date of onset

1015

Chronic interstitial nephritis

1021

Cerebral hemorrhage

July 5, 1027

Contributory causes of importance not related to principal cause:

In a group of causes containing the principal cause and related causes, the causes should be given in the order of onset, so that in a group of three causes the principal cause may appear in either first. second, or third position. The principal cause in the above example happens to be the second cause given.

EXTRACTS FROM THE LA'SSAOF THE COMMONWEALTH OF MASE CHUSETTS GOVERNING THE

RETURN OF CERTIFICATES OF DEATH

A physician or registered hospital medical officer shall forth- with, after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a standard certificate of death, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he dicd, defined as required by section one, where same was contracted, the duration of his last illness, when last seen alive by the physician or officer and the date of his death .... Gen. Laws, Chap. 46, Sec. 9.

No undertaker or other person shall bury or otherwise dispose of a human body in a town, or remove therefrom a human body which has not been buried, until he has received a permit from the board of health, or its agent appointed to issue such permits, or if there is no such board, from the clerk of the town where the person died; and no undertaker or other person shall exhume a human body and remove it from a town, from one cemetery to another, or from one grave or tomb other than the receiving tomb to another in the same cemetery, until he has received a permit from the board of health or its agent aforesaid or from the clerk of the town where the body is buried. No such permit shall be issued until there shall have been delivered to such board, agent or clerk, as the case may be, a satis- factory written statement containing the facts required by law to be returned and recorded, which shall be accompanied, in case of an original interment, by a satisfactory certificate of the attending physician, if any, as required by law, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if, for sufficient reasons, his certificate cannot be obtained early enough for the purpose, or is insufficient, a physician who is a member of the ; board of health, or employed by it or by the selectmen for the purpose. shall upon application make the certificate required of the attending physician. If death is caused by violence, the medical examiner shall make such certificate. If such a permit for the removal of a human body, not previously interred, from one town to another within the common- wealth cannot be obtained early enough for the purpose, the certificate of death made as above provided and in the possession of the undertaker desiring to make such removal shall constitute a permit for such re- moval; provided, that such body shall be returned to the town from which it was removed within thirty-six hours after such removal, unless a permit in the usual form for the removal of such body has been sooner obtained hereunder. If the death certificate contains a recital, as re- quired by section ten of chapter forty-six, that the deceased served in the army, navy or marine corps of the United States in any war in which it has been engaged, such recital shall appear upon the permit. The board of health, or its agent, upon receipt of such statement and certificate, shall forthwith countersign it and transmit it to the clerk of the town for registration. The person to whom the permit is so given and the physician certifying the cause of death shall thereafter furnish for registration any other necessary information which can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require. - Chap. 114, Sec. 45. G. L., as amended by Chap. 48. Acts of 1927 and Chap. 414, Acts of 1931.

Medical examiners shall make examination upon the view of the dead bodies of only such persons as are supposed to have died by violence .... Gen. Laws, Chap. 38, Sec. 6.

RULES OF PRACTICE

The fulfillment of the purpose of these laws calls for the observance of the following rules of practice:

(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease unrelated to any form of injury.

RIR-301A

PLACE OF DEATH

Suffolk /(County) minturip (City or Town) 280 River Rel.

The Commonwealth of Massachusetts OFFICE OF THE SECRETARY DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH

To be filed for burial permit with Board of Health or its Agent.

Registered No. (If death occurred in a hospital or institution,

give its NAME instead of street and number)

2 FULL NAME

...

Morris Simons.

(If deceased is a married, widowed or divorced woman, give also maiden name.)

280 River Rd

.St., .....

.Ward,

(If nonresident, give city or town and state)

mos.

days.

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

18 DATE OF

DEATH

Ceit

(Month)

(Day)

(Year)

I HEREBY CERTIFY, That I attended deceased from

I jast saw h.

allve on

death is said

to have occurred on the date stated above, at 2 A The principal cause of death and related causes of Importance In order of cnset were as follows:

Date of Onset IMPORTANT

et 30

1933

· Contributory causes of importance not related to principal cause:

Name of operation

What test confirmed diagnosis tych

Was there an autopsy ?.

20 Was disease or injury in any way related to occupation of deceased?

If so, specify

(Signed) ..... (Address Truthut Bond / A Data + 31 1935,

M. D.

21 PLACE OF BURIAL.

CREMATION OR REMOVED side of goat west Roy

(Cemetery

(City or town) 19:30

22 NAME OF

UNDERTAKER

ADDRESS

200 grazie 200

Received and filed ...

NOV .1935

...

information sY, I'd be carefully supplied. AGE should be stated EXACTLY. 195R ANS should state is very important. See instructions and extracts from the laws on back of certificate. CAUSE OF DEATH in plain terms, so that it may be properly classified. Exact statement of OCCUPATION

100m-12-'34. No. 2938-f

I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:

(Signature of Agent of Board of Health or other) IHeartte Mixcer 11/1/33

... (Official Designation) VU

(Date of Issue of Permin)

40 ger

12 BIRTHPLACE (City)

(State or country)

Poland

18 NAME OF

HER Samuel Simons

PARENTS

14 BIRTHPLACE OF

FATHER (City)

Poland

(State or country)

15 MAIDEN NAME

OF MOTHER

Bessie Unknown

16 BIRTHPLACE OF MOTHER (City) (State or country) Poland

Relation, if any

annie Simons (profe)

(Address) 280 River Red Flag

Tailor for

9 Industry or business in which work was done, as silk mill, saw mill, bank, etc.

himself.

10 Date deceased last worked at

this occupation (month and

year)

1 day

11 Total time (years) spent in this occupation ......

OCCUPATION

Da If married, widowed, or divorced Quince alexander

HUSBAND of

(Give maiden name of wife in full)

(or) WIFE of

(Husband's name in full)

6 IF STILLBORN, enter that fact here.

AGE

7 71 Years .. Months Days

If less than 1 day

Hours ...

.Minutes

8 Trade, profession, or particular kind of work done, as spinner, sawyer, bookkeeper, etc .......

5 SINGLE

MARRIED

WIDOWED

or DIVORCED

(write the word)

married

3 SEX

male

4 COLOR OR RACE

White

(a) Residence. No.

(Usual place of abode)

Length of residence in city or town where death occurred

FTS.

22Os.

days.

How long in U. S., if of foreign birth?

(L U. S.

War Veteran,

specify WAR)

Winthrop

1935

Inone

Date of.

DATE OF BURIAL

nov. 1

(Registrar)

.St ........................ Ward

Revised United States Standard Certificate of Death

Statement of occupation .- Precise statement of occupation is very important, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupation had been given up or changed on account of the disease causing death, report the occupation prior to illness. If the deceased had retired from business, report the occupation prior to retirement. Children not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework in answer to Question 8 and own home in answer to Question 9. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook-hotel, etc. For a person who had no occupation what- ever write none.

To be complete, an occupation return must state:

8 .- The trade, profession, or particular kind of work done.

9 .- The industry or business in which the work was done.

10 .- The month and year the deceased last worked at the occupation.

11 .- The number of years the deceased followed the occupation.

In stating the occupation, avoid the use of such indefinite terms as "employee," "worker,"""operative," etc. Find out the parti- cular kind of work done and return that, as spinner, weaver, etc.

In stating the industry or business, avoid the use of such general terms as "store,' "factory. " " mill," etc. State the particular kind of store, factory, mill, etc., as grocery store, soap factory, cotton mill, etc.

Distinguish carefully the different kinds of engineers by stating the full descriptive titles, as civil engineer, mechanical engineer, mining engineer, stationary engineer, etc. Avoid the term "laborer" when a more precise statement of the occupation can be secured. Do not use the word "mechanic, " but give the exact occupation, as carpenter" painter, machinist, etc. Distinguish carefully between retail merchants and wholesale merchants. A person who sells goods should be called a salesman and not a clerk.

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Town of Winthrop : Record of Deaths 1935, Part 87

Author: Winthrop (Mass.) Publication date: 1935 Publisher: Number of Pages: 524

Author: Winthrop (Mass.)
Publication date: 1935
Publisher:
Number of Pages: 524